Palmetto Jolley Acres Operating LLC

Enrollment entity

Provider / enrollment organization Enrollment PAC 6305844325 Enrollment ID O20061129000154

Linked facilitiesFacilities

StatesStates

4 parties: 1 organizations · 3 individuals

Owners & control parties

Name	Owner/control PAC	Type	Role(s)	%
Gwendolyn A Robinson	4183942006	Individual	W-2 Managing Employee	—
Palmetto Health Care LLC	2062410111	Organization	5% or Greater Direct Ownership Interest	100
Murray Forman	4789622614	Individual	5% or Greater Indirect Ownership Interest	99
Kenneth A Tabler	6406990936	Individual	Corporate Officer	—

Gwendolyn A RobinsonPAC 4183942006
IndividualW-2 Managing Employee
Palmetto Health Care LLCPAC 2062410111
Organization1005% or Greater Direct Ownership Interest
Murray FormanPAC 4789622614
Individual995% or Greater Indirect Ownership Interest
Kenneth A TablerPAC 6406990936
IndividualCorporate Officer

Facility	Location	Role / stake	HPRD	Ratings	Census	Flags
Jolley Acres Healthcare Center Palmetto Jolley Acres Operating LLC 57 residents		Other disclo…	3.31	Ovr★★★★☆Stf★★☆☆☆Ins★★★★☆QM★★★☆☆	57

Jolley Acres Healthcare Center
Palmetto Jolley Acres Operating LLC
Other disclosed role57 res3.31 HPRD
Overall 4Staffing Staff 2

Related CMS associates

Name match to Palmetto Jolley Acres Operating LLC in FEC filings. Similar names may appear—confirm on FEC.gov.